Predicting Long‑Term Cardiovascular Events after Transient Ischemic Attacks: Carotid Artery Intima‑Media Thickness or ABCD2 Score or Both?

Fariborz Khorvash, Helia Hemasian, Shahab Shahabi, Arvin Shahzamani, Erfan Sheikhbahaei, Ahmad Chitsaz


Background: Patients who experienced transient ischemic attack (TIA) are at high‑risk for cardiovascular events. This study aims to evaluate diagnostic value of carotid artery intima‑media thickness (CIMT) and ABCD2 score for predicting cardiovascular events in long‑term follow‑up
after TIA. We prospectively included sixty patients with TIA who admitted to hospital from March 2016 to August 2016.

Methods: Duplex ultrasonography of internal carotid arteries was performed. ABCD2 scores were evaluated for each patient. At a median follow‑up of 20 months, patients were asked about new cardiovascular events. We used IBM SPSS software version 22.0 with Chi‑squared,
t‑test, ANOVA, receiver operating characteristic, and area under the curve (AUC) analysis for our work.

Results: Sensitivity and negative predictive value of the combined score (ABCD2+CIMT) was the highest (96.3% and 90.9%, respectively), and the specifcity and positive predictive value of the CIMT were the highest (57.5% and 63.1%, respectively) to predict cardiovascular events in long‑term.

Conclusion: Compared to ABCD2 score, CIMT proved to be more accurate to predict cardiovascular events in long‑term follow‑ups (AUC = 0.736 vs. AUC = 0.640). However, adding CIMT value to ABCD2 score was even better (AUC = 0.750). Therefore, CIMT measurement in the ABCD2 score after TIA enables prediction of long‑term cardiovascular events.

Keywords: Area under curve, carotid intima‑media thickness, receiver operating characteristic curve, stroke, transient ischemic attack

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